胰肾联合移植受者发生多重耐药菌感染的危险因素及生存分析

Risk factors and survival analysis for multi-drug resistant organism infections in recipients of simultaneous pancreas-kidney transplantation

目的总结胰肾联合移植(simultaneous pancreas and kidney transplantation,SPK)受者术后发生多重耐药菌(multi-drug resistant organism,MDRO)感染的危险因素,探讨MDRO感染对SPK受者存活的影响。方法回顾性分析2016年1月至2022年12月在广州医科大学附属第二医院行SPK 218例受者临床资料,分析供受者标本来源及MDRO病原菌的构成比例。根据移植术后是否发生MDRO感染将受者分为MDRO组(98例)和无MDRO组(120例),比较两组供受者的临床资料,采用二元logistic回归分析发生MDRO感染的危险因素;采用Kaplan-Meier法比较两组受者的存活率。结果218例受者中,共有98例(45%)受者出现MDRO感染,标本痰液46例(46.9%)及尿液34例(34.7%),超广谱β-内酰胺酶阳性耐药菌49例(50%)。肺炎46例(46.9%)、泌尿道感染34例(34.7%)、腹腔感染16例(16.3%)、血行感染2例(2.0%)。单因素分析结果显示:肾衰竭时间(P=0.037)、住院时间(P<0.001)、抗生素使用时间(P<0.001)、新增抗生素(P=0.014)、白蛋白(P<0.001)、白细胞计数(P<0.001)是发生MDRO感染的危险因素。多因素分析结果显示:低白蛋白血症(OR=0.855,95%CI:0.790~0.925,P<0.001)、白细胞计数减少(OR=0.656,95%CI:0.550~0.783,P<0.001)是发生MDRO感染的独立危险因素。MDRO组受者术后1年和3年存活率分别为92.9%(91/98)和89.8%(88/98),无MDRO组受者术后1年和3年的存活率均为96.7%(116/120);两组受者1年存活率比较差异无统计学意义(P=0.201),3年存活率比较差异有统计学意义(P=0.041)。结论低白蛋白血症、白细胞计数减少是发生MDRO感染的危险因素。MDRO感染受者存活有一定影响。

ObjectiveTo summarize the distributional characteristics of postoperative occurrence of multi-drug resistant organism(MDRO)infections and their risk factors in simultaneous pancreas-kidney transplantation(SPK)recipients and examine the impact of MDRO infections on the survival of SPK recipients.MethodFrom January 2016 to December 2022,the relevant clinical data were retrospectively reviewed for 218 SPK recipients.The source of donor-recipient specimens and the composition percentage of MDRO pathogens were examined.According to whether or not MDRO infection occurred post-transplantation,they were assigned into two groups of MDRO(98 cases)and non-MDRO(120 cases).The clinical data of two groups of donors and recipients were analyzed.And the risk factors for an onset of MDRO infection were examined by binary Logistic regression.The survival rate of two recipient groups was compared by Kaplan-Meier method.ResultA total of 98/218 recipients(45%)developed MDRO infections.And 46(46.9%)of sputum and 34(34.7%)of urine were cultured positively and 49(50%)pathogens expressed extended spectrum beta-lactamase.There were pneumonia(46 cases,46.9%),urinary tract infections(34 cases,34.7%),abdominal infections(16 cases,16.3%)and bloodstream infections(2 cases,2.0%).Univariate regression analysis revealed that length of renal failure(P=0.037),length of hospitalization(P<0.001),length of antibiotic use(P<0.001),novel antibiotics(P=0.014),albumin(P<0.001)and leukocyte count(P<0.001)were risk factors for an onset of MDRO infections.The results of multifactorial regression indicated that low albumin(OR=0.855,95%CI:0.790~0.925,P<0.001)and leukopenia(OR=0.656,95%CI:0.550~0.783,P<0.001)were independent risk factors for an onset of MDRO infections.The survival rates of recipients in MDRO group at Year 1/3 post-operation were 92.9%(91/98)and 89.8%(88/98).And the survival rate of recipients in non-MDRO group was 96.7%(116/120)at Year 1/3 post-operation.Inter-group difference was not statistically significant in 1-year survival rate of two recipient groups(P=0.201);statistically significant inter-group difference in 3-year survival rate between two recipient groups(P=0.041).ConclusionLow albumin and leukopenia are risk factors for MDRO infection.Infection with MDRO has some impact on the survival of recipients.